The Second Draw

Twice this month I went to the emergency department. The first time, early in the morning, I was in too much pain to notice anything. The second time it was chest pain, and I went in out of an abundance of caution, which meant I was well enough to watch.

So I watched. The blood work looked a great deal like the panel I had a few weeks earlier. Then the physician told me she would need to draw again in two hours. The repeat was necessary, she said. I nodded, and somewhere behind the nod a word arrived on its own: redundant.

I did not think it unkindly. At first I found it interesting. I have spent a career looking at systems, and duplication is one of the first things a systems eye learns to spot. Most of the time, spotting it is a service.

Then I waited. Two hours is a long time on a gurney when you have already decided the answer is in. I would like to report that I waited well. I did not. I was impatient, and I suspect it showed.

This time I had it backwards.

The test was troponin, and in a chest pain workup it is drawn more than once, hours apart. One reading is a snapshot. It cannot tell you whether something is quietly starting or whether nothing is happening at all. A second reading can, because what matters is whether the number moves. That answer does not exist until the second draw creates it. A body cannot be known in the abstract. It has to be asked again, and given time to answer.

So she was not running the same test again. She was making sure the first answer held. The two hours I spent resenting were not a delay in the work. They were the work.

My word had arrived before the facts did. The obvious reading had to fail before I could see what was in front of me.

Both readings came back negative. Nothing was moving. I went home.

There is a phrase we use in our sector: standing in the gap. We say it about the colleague who covers a vacancy, the one who stays late, the one carrying two jobs. We say it so often it has worn smooth. Taken literally, though, it is impossible. A gap is the place where nothing is. To stand in it is to hold a position that cannot be held. The older sense is a breach in a wall, and someone willing to stand in it so that what is behind the wall stays safe.

I watched someone do the literal version, and it looked like nothing at all.

Here is what I think it cost her. This is my reading, not her account; I never asked. She made room for a question that looked, to me at least, as if it had already been answered, and making room for someone else always comes at your own expense. Part of the expense was time. Part was money that was not hers to spend. Part was the risk of looking excessive to whoever reads the chart later. And part, I suspect, was me: two hours of a patient who had already decided he was fine. None of the first physician’s good work could be borrowed. Whatever had been settled weeks before, she could not take on faith that it was still settled. The responsibility was hers, new, that day.

She did it anyway.

That is the part I keep returning to. The people who stand in the gap mostly do it where the person they are protecting will never see it. When it works, nothing happens. In my case nothing happened twice, two hours apart, and I was annoyed about it. Nothing happening is the whole point, and it is also very hard to thank.

We have these people in our work. The colleague who writes the donor record note with care for a successor who may never be hired. The one who does the due diligence on a gift that was going to close anyway, because the donor deserves to have it done. The one who goes back after the first yes, not to ask again, but to find out whether it held. None of that looks like heroism. Most of it shows up, if at all, as a line someone else reads later and considers redundant.

I want to thank her, and them, plainly. Not because they are heroes. Because they made room for someone else at their own expense, out of sight, and they did it without knowing whether anyone would notice. Including, sometimes, the person they made room for.

What I learned is simple. The second draw was not a repeat. The first told her where things stood. Only the second could tell her which way they were going. And the person who orders it again, knowing how it might look and knowing you would rather go home, is the one standing in the gap.